1. Cardiovascular Emergencies
Chapter 5

2. Introduction Can be most Challenging
Recognition and care can mean life or death
Most athletes are not in profile of heart attack and stroke
Other conditions such as congenital defects and trauma do occur
These like all emergencies must be anticipated
Health care providers must be proficient in resuscitative skills

3. Anatomy Review Heart Positioned centrally in thoracic cavity
1/3 is posterior to sternum
Remainder is to the left
4 chambers enclosed in pericardium
Atria- upper
Ventricles- lower
4 valves
Tricuspid
Mitral
Aortic
Pulmonic

4. Blood flow

5. Chest Pain or discomfort
Can be result of cardiac and non-cardiac events
Considered cardinal sign of cardiac-related event
Must be assessed thoroughly regardless of age and fitness level
Other descriptors an individual may describe:
Discomfort
Ache
Burning
Fullness
All situations with chest pain should be treated as a cardiac event until proven otherwise

6. Common Causes of chest pain
Cardiac
Noncardiac
Myocardial Infarction
Gastro reflux
Angina
Esophagitis
Hypertrophic cardiomyopathy
Esophageal spasm
Aortic Stenosis
Ulcers
Cardiac Tamponade
Asthma
Cardiac Contusion
Gastritis
Coronary artery disorder
Pneumothorax
Valve disorders
Pulmonary Embolism
Aortic dissection
Pleuritis
Bronchitis
Rib Fractures

7. Sudden Cardiac Arrest Or SCA is Sudden Cardiac Death
Sudden loss of heart function
#1 cause of death in young athletes
Can be caused by traumatic or atraumatic events
Traumatic
Commotio Cordis
Atraumatic
Hypertrophic Cardomyopathy
Can have no warning signs
Signs with exertion can occur
Chest discomfort
Shortness of breath
syncope

8. Management of SCA
August 2006, a multidisciplinary group lead b the NATA made recommendations on steps to follow to manage SCA
Training in CPR and AED use for all first responders
Early activation of EMS, Early CPR, Early Defibrillation, and rapid advancement to advanced cardiac life support
High suspicion of SCA on any unconscious or unresponsive athlete
Training to recognize SCA with ability to accurately take and recognize pulse, respiration rate, and seizure activity
Knowledge of Commotio Cordis
More on pages 53 and 54

9. More common cardiovascular events
Myocardial Infarction (Heart Attack)
S&S: profuse sweating, difficulty breathing, nausea, dizziness, pain radiating to neck, jaw, arms, and back; some may complain of pressure or ache rather than pain
Management: place in position of comfort, loosen restrictive clothing, oxygen administration if available and trained, EMS activation immediately, continue to monitor vital signs, CPR and AED if condition worsens
Angina Pectoris
S&S: Similar to Myocardial Infarction
Management: Most have been diagnosed previously with this condition and will have nitroglycerin medication prescribed. If condition is unknown treat like myocardial infarction

10. More common cardiovascular events
Stroke
S&S: Sudden numbness; decrease or loss of function in face, arm, leg, usually only affecting one side of the body; severe headache; vision problems; unequal pupils; loss of balance; mental confusion; difficulty speaking or swallowing; loss of bowel or bladder control
Management: protect airway; assess vital signs; detailed history with physical exam; administer oxygen if trained; alert EMS; transport to nearest hospital immediately; favorable prognosis if treated immediately
Cardiac Tamponade
S&S: shock; hypotension; jugular vein distension; muffled heart sounds; paradoxical pulse; DD in field may be tension pneumothorax, difference will be location of trachea location
Management: protect airway; assess vital signs; detailed history with physical exam; administer oxygen if trained; alert EMS; transport to nearest hospital immediately

11. More common cardiovascular events
Traumatic Aortic Rupture
S&S: extremely difficult to diagnosis; consider MOI; often show no outward signs of chest trauma; may present with UE hypertension and LE diminished pulse
Management: majority die immediately; if survival emergency surgery is needed immediately; activate EMS; monitor vitals; prepare for CPR and AED if situation deteriorates
Myocardial Contusion
S&S: same as an acute myocardial infarction; hard to differentiate in field; MOI may assist in diagnosis
Management: : place in position of comfort, loosen restrictive clothing, oxygen administration if available and trained, EMS activation immediately, continue to monitor vital signs, CPR and AED if condition worsens

12. More common cardiovascular events
Cardiac Arrhythmias
S&S: most present in PPEs; some can present only after symptoms of a cardiac event; many types exist; when symptomatic may present with palpitations, syncope, near syncope, dizziness, fatigue, or sudden death
Management: place in position of comfort, loosen restrictive clothing, oxygen administration if available and trained, EMS activation immediately, continue to monitor vital signs, CPR and AED if condition worsens
Myocarditis
S&S: cough, SOB , chest pain, intensify with exercise; may exhibit flu like symptoms including body ache, joint pain, headache, sore throat, fever, and diarrhea; can lead to further more dangerous and fatal arrhythmias

13. More common cardiovascular events
Syncope
S&S: loss of consciousness; can be benign or due to cardiac event
Management: thorough assessment; never assume; if cardiac event suspected treat as such
Valve and Blood Vessel Disorders
S&S: may types that can turn into cardiac event upon exertion; difficult and near impossible to detect without thorough medical history
Management: if cardiac event suspected treat as such